Twin Healing Traditions

Are religious beliefs related to physical health? Is spiritual practice relevant to health care? Harold G. Koenig, director of Duke University’s Center for Spirituality, Theology, and Health, explores varying perspectives on these two seemingly different endeavors and reveals their interconnectedness throughout human history.

Many today might think that religion and medicine are two very different endeavors, that the mere suggestion that religion is relevant to health and health care is something new and different. However, this is not true. What is new and different is the distinct separation of religion from medicine, a relatively recent phenomenon in the United States and that, in some countries, has still not occurred. Throughout most of recorded history, religion and medicine have been strongly linked together in one way or another and physical disease understood largely in religious or spiritual terms. Consider the following.

Artifacts from the prehistoric Egyptian period (6000–5000 BC) suggest that mental and physical illnesses were not distinguished from one another and both were thought to be caused by evil spirits, demon possession, or other spiritual forces. The same was true for Mesopotamian medicine between 3200–1025 BC, which was based on a mixture of supernatural and natural explanations for illness. Treatments were applied through spiritual practices at times and at other times through natural methods involving plant leaves, roots, and mixtures of animal parts. In the Indus Valley civilization (2300–1700 BC), the early Hindu priest—who also served the role of physician—performed rituals of dancing, recited incantations, and used amulets in attempts to cure disease. Herbs, liquid potions, and cow by-products were also administered with the hope of relieving mental or physical illness.

While early Greek medicine (350 BC and thereafter) established by Hippocrates focused on achieving a balance of bodily fluids or humors (considered to be scientific medicine), Platonic medicine mixed science with mystical elements and Asclepian medicine treated illness by means of astrology, magic, and herbs. While private physicians attended the wealthy, most of the common people sought cures through miraculous healing, relied on folk remedies, or after 400 AD, sought help from clergy with medical skills. Indeed, prior to the Christian era, there were no hospitals for care of the sick in the general population. During Greek and Roman times, persons unable to afford a private physician or treatment in an Asclepian temple were either cared for by their families or simply left to die unattended.

The first major hospital in Western civilization was built in Asia Minor (present day Turkey) around 370 AD by the bishop of Caesarea, Saint Basil the Great. His actions were motivated by the Biblical injunction to clothe the poor and heal the sick. Consequently, most physicians throughout the Middle Ages from 400 AD through 1400 AD were monks or priests and care of the poor and sick was provided primarily by clergy. In the sixth century, mentally ill persons were cared for in monasteries run by the Church, and after the 12th century, mental patients in Gheel, Belgium, were brought into Christian homes and included in family life. For centuries later, the Church would continue to be active in caring for the mentally ill, establishing institutions operated by clergy in Spain during the early 1400s. These hospitals provided exemplary care—care that secular institutions could not match until recent times. In 1817, the Quakers established the first mental hospital (Friends Asylum) in the United States just outside of Philadelphia, applying “moral treatment” to its patients with remarkable success, and would be the model for care of the mentally ill for the next 150 years in the this country.

After establishing the first hospitals for treatment of the physically ill during the early Middle Ages, the Church would operate and staff most hospitals in the Western world for nearly 1,500 years. In the late Middle Ages, it was the Church that licensed physicians to practice medicine. With the beginning of the Renaissance period (1400s), however, certification of doctors became a responsibility of the state—heralding a growing separation between medicine and religion. During the Enlightenment period that followed the Renaissance in Europe, the Church continued to lose more and more control over the health care professions (especially physicians). The secularization of healthcare was sped up by the spectacular scientific discoveries in the 18th century. By the end of the French Revolution in 1802, the separation of medicine from religion had become nearly complete. Medicine and religion would grow more and more separate with time, and as scientific medicine progressed after World War II, religion’s influence soon disappeared (with the exception of hospitals that carried religious names).

The nursing profession, however, was one of the last bastions to give in to secularization. It was the Daughters of Charity of St. Vincent de Paul during the 1600s in Europe that organized Catholic nuns to serve as “nurses” caring for the sick in both religious and secular hospitals. By 1789, there were 426 hospitals run by the Daughters of Charity in France alone, and by the early 1800s, they had set up the first nursing group in the United States, in Emmitsburg, Maryland. Many religious traditions continued until the 1950s and 1960s in the United States, including the requirement that nurses live next to the hospital together and could not be married. In fact, the nurse’s white cap, which was worn by nurses until only recently, is directly descended from the large white winged habits of the Daughters of Charity.

While religion, medicine, and nursing have in modern times become largely separate, there are inklings of change. In 1990, fewer than five medical schools in the United States taught students about the role that spirituality played in the lives of sick patients. Today, over 90 percent of the 122 U.S. medical schools now have either content in required courses or elective courses on religion, spirituality, and medicine. Are we now seeing the gap closing between the twin healing traditions of medicine and religion? What is driving this change?